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From the 9/17/2021 release of VAERS data:

This is VAERS ID 1277706



Case Details

VAERS ID: 1277706 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-27
Onset:2021-04-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Echocardiogram abnormal, Electrocardiogram ST segment elevation, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Myocardial infarction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to urgent care with chest pain that started on 4/30/2021. EKG with diffuse ST elevation, consistent with Pericarditis. Sent to ED for further care and management.


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